Checklists & workflows
Interactive readiness checklists for common billing tasks.
- ABN issuance checklist
A session-only operational checklist covering the steps a Medicare billing team works through when an Advance Beneficiary Notice of Noncoverage (ABN) may be needed before delivering an Original Medicare service that is expected to be denied or found not medically necessary. It frames the durable, structural elements of ABN issuance and points to CMS for the current form version, mandatory-use situations, and modifier conventions, without asserting figures or deadlines that vary by contractor, service, or date.
- Authorization denial prevention checklist
Review the controls that keep an approved authorization from still turning into a denied claim.
- Behavioral health claim readiness checklist
A session-only operational checklist covering the readiness steps that commonly precede submitting a behavioral health claim: eligibility and carve-out verification, benefit and parity considerations, prior authorization, documentation and medical necessity, code family and unit selection, rendering-provider enrollment, place of service and telehealth, confidentiality under 42 CFR Part 2, coordination of benefits, and timely filing. It is an educational reference; because specific rules vary by payer, plan, state, and program, items point to authoritative sources rather than quoting figures.
- Behavioral health documentation checklist
A session-only operational checklist of the documentation elements billing teams commonly verify before submitting a behavioral health claim — medical necessity, service type and time, rendering provider, place of service, authorizations, and confidentiality handling — with each requirement pointing to the governing payer, program, or federal source rather than a fixed rule.
- Clean claim submission readiness checklist
Review the operational inputs that should be checked before a professional claim is released.
- Corrected claim submission checklist
Review the prior claim, supported change, payer references, transaction path, release evidence, and follow-up before submitting a correction.
- Denial appeal readiness checklist
Review the evidence, deadline, ownership, and submission controls for a claim appeal.
- Good Faith Estimate checklist
A session-only checklist for confirming all required Good Faith Estimate elements before furnishing scheduled services to self-pay patients.
- Medicaid claim readiness checklist
A structured, session-only readiness checklist covering the items commonly verified before a Medicaid claim is submitted — enrollment, eligibility, coverage type, prior authorization, coordination of benefits, coding source data, and timely filing. Because Medicaid is jointly funded by the federal and state governments and administered by each state, specific rules, deadlines, and covered services vary by state and by managed care plan; this reference points to authoritative sources rather than quoting figures.
- Medicaid enrollment checklist
A structural, session-only checklist for preparing a Medicaid provider enrollment application. It walks through provider identity, state portal and application type, screening and disclosures, managed-care contracting, and post-enrollment maintenance. Because Medicaid is state-administered, forms, fees, screening levels, and timelines vary by state, provider type, and program, so each item points to the authoritative source rather than a fixed rule.
- Medicare claim readiness checklist
A session-only, educational checklist of the structural items a biller reviews before submitting a traditional Medicare fee-for-service claim: beneficiary identity, enrollment and assignment status, coverage and medical-necessity documentation, secondary-payer order, and timely filing. Because many specifics vary by Medicare Administrative Contractor (MAC), plan, service, and date, each item points to the authoritative CMS source rather than quoting figures.
- Modifier 25 and 59 documentation checklist
A session-only checklist for confirming that documentation supports modifier 25 or 59 before claim submission.
- New patient registration data checklist
Review the demographic and coverage data captured at registration that a clean eligibility check and a clean claim both depend on.
- No Surprises Act patient notice checklist
A session-only checklist for confirming NSA-required patient notices and protections before billing out-of-network charges.
- Patient eligibility verification checklist
Review the front-end coverage and benefit checks that should be completed before a patient's visit.
- Payer enrollment readiness checklist
A session-only operational checklist covering the structural inputs typically needed to prepare a Medicare, Medicaid, or commercial payer enrollment before submission, with variation by program, payer, plan, state, and effective date flagged throughout. Educational reference only; collects no data and stores nothing.
- Prior authorization request checklist
Review the inputs to confirm before submitting a prior authorization request, so it is complete the first time.
- Professional claim release checklist
Review source readiness, claim data, exceptions, versioning, batch controls, and response ownership before releasing professional claims.
- Provider credentialing document checklist
A session-only, educational checklist of the document categories typically assembled when credentialing a healthcare provider and preparing payer enrollment applications. It organizes the credentialing file into durable, structural categories and points to authoritative standards where requirements vary by payer, plan, state, or program. No patient information is involved.
- Revenue cycle governance readiness checklist
Check whether a revenue cycle process has clear ownership, decision rights, controls, escalation paths, evidence, and review triggers.
- Revenue cycle process handoff checklist
Review the work item, required information, sender, receiver, acceptance, exceptions, timing, and evidence at a revenue-cycle handoff.
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